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October 1982, Vol 136, No. 10 >
Article | October 1982

Pneumococcal Subcutaneous Abscess in Immunocompetent Children FREE

THOMAS E. LISTON, MD
Am J Dis Child. 1982;136(10):947-948. doi:10.1001/archpedi.1982.03970460077019.
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References
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Skin and subcutaneous involvement is distinctly unusual when the infecting organism is Streptococcus pneumoniae. Cellulitis associated with bacteremia due to S pneumoniae has been reported in adults with drug addiction1 and macroglobulinemia2 and in children with facial cellulitis.3 From both blood and subcutaneous aspirate cultures, Fleisher et al4 isolated S pneumoniae from one of 25 children who were seen in their emergency department with cellulitis. I am aware of only one previously reported case of a subcutaneous abscess caused by this organism. In that patient, an adult who had had a splenectomy for idiopathic thrombocytopenic purpura 14 months before, blood cultures were negative but a fluctuant mass on the shoulder disclosed S pneumoniae on smear and culture.5 I report two cases of pneumococcal subcutaneous abscess in otherwise healthy children and suggest that their infections occurred as an unusual complication of occult pneumococcal bacteremia.

Methods.—The

REFERENCES

1 +
Lewis RJ, Richmond AS, McGrory JP:  Diplococcus pneumoniae cellulitis in drug addicts . JAMA 1975;;232:54-55.
2 +
Milstein P, Gleckman R:  Pneumococcal erysipelas: A unique case in an adult . Am J Med 1975;;59:293-296.
3 +
Thirumoorthi MC, Asmar BI, Dajani AS:  Violaceous discoloration in pneumococcal cellulitis . Pediatrics 1978;;62:492-493.
4 +
Fleisher G, Ludwig S, Campos J:  Cellulitis: Bacterial etiology, clinical features, and laboratory findings . J Pediatr 1980;;97:591-593.
5 +
Michael MI III, Cannon NJ:  Primary pneumococcal abscess in an asplenic host . Ala J Med Sci 1974;;11:308-311.
6 +
Facklam RR:  Streptococci and aerococci , in Lennette EH, Balows A, Hausler WJ Jr, et al (eds): Manual of Clinical Microbiology , ed 3. Washington, DC, American Society for Microbiology, 1980;, pp 88-110.
7 +
Jackson AL, Davis NC:  Quantitation of immunoglobulins , in Rose NR, Friedman H (eds): Manual of Clinical Immunology , ed 2. Washington, DC, American Society for Microbiology, 1980;, pp 109-120.
8 +
McGowan JE Jr, Bratton L, Klein JO, et al:  Bacteremia in febrile children seen in a 'walk-in' pediatric clinic . N Engl J Med 1973;;288:1309-1312.
9 +
Teele DW, Pelton SI, Grant MJA, et al:  Bacteremia in febrile children under 2 years of age: Results of cultures of blood of 600 consecutive febrile children seen in a 'walk-in' clinic . J Pediatr 1975;;87:227-230.
10 +
McCarthy PL, Grundy GW, Spiesel SZ, et al:  Bacteremia in children: An outpatient clinical review . Pediatrics 1976;;57:861-868.
11 +
Myers MG, Wright PF, Smith AL, et al:  Complications of occult pneumococcal bacteremia in children . J Pediatr 1974;;84:656-660.
12 +
Bratton L, Teele DW, Klein JO:  Outcome of unsuspected pneumococcemia in children not initially admitted to the hospital . J Pediatr 1977;; 90:703-706.
13 +
Burech DL, Koranyi K, Haynes RE, et al:  Pneumococcal bacteremia associated with gingival lesions in infants . Am J Dis Child 1975;; 129:1283-1284.
14 +
Dickey JW Jr:  Extra pulmonary abscesses due to Diplococcus pneumoniae . J Fla Med Assoc 1970;;57:43-44.
15 +
Chulay JD, Lankerani MR:  Splenic abscess: Report of ten cases and review of the literature . Am J Med 1976;;61:513-522.
16 +
Halliday P, Halliday JH:  Subphrenic abscess: A study of 241 patients at the Royal Prince Edward Hospital, 1950-73 . Br J Surg 1976;; 63:352-366.
17 +
Garfield J:  Management of supratentorial intracranial abscess: A review of 200 cases . Br Med J 1969;;2:7-11.
18 +
Rymer MM, Kao CC:  Pitfalls in the diagnosis of low-back and leg pain . Postgrad Med 1974;;56:76-80.
19 +
Reddy DR, Rao GN, Krishnamurthy D:  Pneumococcal spinal subdural abscess (a case report) . J Postgrad Med 1973;;19:190-192.
20 +
Enberg RN, Kaplan RJ:  Spinal epidural abscess in children . Clin Pediatr 1974;;13:247-253.
21 +
Harvey JS, Freeman R, Corbett PJ:  A case of pneumococcal typhlitis . Arch Surg 1976;;111: 890.
22 +
Dimond M, Proctor HJ:  Concomitant pneumococcal appendicitis, peritonitis and meningitis . Arch Surg 1976;;111:888-889.
23 +
Waldman JD, Rosenthal A, Smith AL, et al:  Sepsis and congenital asplenia . J Pediatr 1977;;90:555-559.
24 +
Padmanabhan J, Risemberg HM, Rowe RD:  Howell-Jolly bodies in the peripheral blood of full-term and premature neonates . Johns Hopkins Med J 1973;;132:146-150.
25 +
Cole FS, Saryan JA, Smith AL:  The risk of additional systemic bacterial illness in infants with systemic Streptococcus pneumoniae disease . J Pediatr 1981;;99:91-94.
26 +
Stossel TP:  Phagocytosis . N Engl J Med 1974;;290:717-723, 774-780, 833-839.

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References

1 +
Lewis RJ, Richmond AS, McGrory JP:  Diplococcus pneumoniae cellulitis in drug addicts . JAMA 1975;;232:54-55.
2 +
Milstein P, Gleckman R:  Pneumococcal erysipelas: A unique case in an adult . Am J Med 1975;;59:293-296.
3 +
Thirumoorthi MC, Asmar BI, Dajani AS:  Violaceous discoloration in pneumococcal cellulitis . Pediatrics 1978;;62:492-493.
4 +
Fleisher G, Ludwig S, Campos J:  Cellulitis: Bacterial etiology, clinical features, and laboratory findings . J Pediatr 1980;;97:591-593.
5 +
Michael MI III, Cannon NJ:  Primary pneumococcal abscess in an asplenic host . Ala J Med Sci 1974;;11:308-311.
6 +
Facklam RR:  Streptococci and aerococci , in Lennette EH, Balows A, Hausler WJ Jr, et al (eds): Manual of Clinical Microbiology , ed 3. Washington, DC, American Society for Microbiology, 1980;, pp 88-110.
7 +
Jackson AL, Davis NC:  Quantitation of immunoglobulins , in Rose NR, Friedman H (eds): Manual of Clinical Immunology , ed 2. Washington, DC, American Society for Microbiology, 1980;, pp 109-120.
8 +
McGowan JE Jr, Bratton L, Klein JO, et al:  Bacteremia in febrile children seen in a 'walk-in' pediatric clinic . N Engl J Med 1973;;288:1309-1312.
9 +
Teele DW, Pelton SI, Grant MJA, et al:  Bacteremia in febrile children under 2 years of age: Results of cultures of blood of 600 consecutive febrile children seen in a 'walk-in' clinic . J Pediatr 1975;;87:227-230.
10 +
McCarthy PL, Grundy GW, Spiesel SZ, et al:  Bacteremia in children: An outpatient clinical review . Pediatrics 1976;;57:861-868.
11 +
Myers MG, Wright PF, Smith AL, et al:  Complications of occult pneumococcal bacteremia in children . J Pediatr 1974;;84:656-660.
12 +
Bratton L, Teele DW, Klein JO:  Outcome of unsuspected pneumococcemia in children not initially admitted to the hospital . J Pediatr 1977;; 90:703-706.
13 +
Burech DL, Koranyi K, Haynes RE, et al:  Pneumococcal bacteremia associated with gingival lesions in infants . Am J Dis Child 1975;; 129:1283-1284.
14 +
Dickey JW Jr:  Extra pulmonary abscesses due to Diplococcus pneumoniae . J Fla Med Assoc 1970;;57:43-44.
15 +
Chulay JD, Lankerani MR:  Splenic abscess: Report of ten cases and review of the literature . Am J Med 1976;;61:513-522.
16 +
Halliday P, Halliday JH:  Subphrenic abscess: A study of 241 patients at the Royal Prince Edward Hospital, 1950-73 . Br J Surg 1976;; 63:352-366.
17 +
Garfield J:  Management of supratentorial intracranial abscess: A review of 200 cases . Br Med J 1969;;2:7-11.
18 +
Rymer MM, Kao CC:  Pitfalls in the diagnosis of low-back and leg pain . Postgrad Med 1974;;56:76-80.
19 +
Reddy DR, Rao GN, Krishnamurthy D:  Pneumococcal spinal subdural abscess (a case report) . J Postgrad Med 1973;;19:190-192.
20 +
Enberg RN, Kaplan RJ:  Spinal epidural abscess in children . Clin Pediatr 1974;;13:247-253.
21 +
Harvey JS, Freeman R, Corbett PJ:  A case of pneumococcal typhlitis . Arch Surg 1976;;111: 890.
22 +
Dimond M, Proctor HJ:  Concomitant pneumococcal appendicitis, peritonitis and meningitis . Arch Surg 1976;;111:888-889.
23 +
Waldman JD, Rosenthal A, Smith AL, et al:  Sepsis and congenital asplenia . J Pediatr 1977;;90:555-559.
24 +
Padmanabhan J, Risemberg HM, Rowe RD:  Howell-Jolly bodies in the peripheral blood of full-term and premature neonates . Johns Hopkins Med J 1973;;132:146-150.
25 +
Cole FS, Saryan JA, Smith AL:  The risk of additional systemic bacterial illness in infants with systemic Streptococcus pneumoniae disease . J Pediatr 1981;;99:91-94.
26 +
Stossel TP:  Phagocytosis . N Engl J Med 1974;;290:717-723, 774-780, 833-839.

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